Bipolar disorder is a lifelong mental disorder that involves dramatic changes in mood, energy, and activity levels.

Neuraxpharm provides medication alternatives for bipolar disorder and once your doctor has determined your specific needs, they can prescribe the product that best adapts to your needs and condition.

Find out about the different types of bipolar disorder, how they can be managed, and ongoing research into the condition.

What is bipolar disorder?

Bipolar disorder is a mental health condition, formerly known as manic depression, that affects mood. It is characterised by extreme shifts in mood, from ‘manic’ episodes to depression, that affect the ability to concentrate and carry out everyday tasks. It is a lifelong condition; however, with ongoing treatment and interventions, people with bipolar disorder can live a productive, healthy life.

What are the main types of bipolar disorder?

There are three types of bipolar disorder which all involve definite extreme changes in mood but have different levels of severity.

The condition is characterised by manic episodes that involve extremely elated, irritable, or energised behaviour and depressive episodes that involve sadness, indifference, or feelings of hopelessness. Less severe manic periods are known as ‘hypomanic episodes’. During these periods a person usually feels fine, but friends or family members notice changes in mood or activity levels.

  • Bipolar I disorder: The classic form, this is defined by acute manic episodes that last at least seven days or by severe manic symptoms for which a person needs hospitalisation. Depressive episodes, usually lasting at least two weeks, often occur as well.
  • Bipolar II disorder: This type does not feature manic episodes, but instead involves at least one hypomanic episode and one period of significant depression.
  • Cyclothymic disorder (or cyclothymia): Moods fluctuate between hypomania and mild or moderate depression, but people do not experience full manic or depressive episodes.

People can experience both manic and depressive episodes at the same time (for example, feeling energised but sad and empty). This is known as an episode of mixed features.

Sometimes, people experience some symptoms of bipolar disorder but do not fit into any of the three types above; they are said to have other specified and unspecified bipolar or related disorders.

How many people have bipolar disorder?

Around 2.4% of the population is affected globally – about 46 million people. Of these, 52% are female and 48% are male. However, the prevalence of bipolar disorder varies across the world from 0.3% to 1.2% by country.
In Europe, research has indicated that around 1% of the population (one in 100 people) are likely to be diagnosed with bipolar disorder in their lives. It can occur at any age and affects men and women from all backgrounds.,

Symptoms

Symptoms of bipolar disorder can vary from person to person, but they typically involve episodes of mania and episodes of depression.

What are the symptoms of bipolar disorder?

Bipolar disorder is characterised by periods of extreme and intense mood that are not typical and often not recognised by the person experiencing them. They can affect sleep, energy, and activity and can last for several days or weeks, making it difficult to lead a functional life.

Manic episodes may include:

  • Feeling high or elated
  • Feeling irritable
  • Needing less sleep
  • Trying to do lots of things at once
  • Talking a lot
  • Feeling powerful and important
  • Feeling jumpy
  • Experiencing loss of appetite
  • Doing things to excess or recklessly

Depressive episodes may include:

  • Feeling sad and empty
  • Feeling worried, hopeless, or worthless
  • Having difficulty concentrating or making decisions
  • Having little interest in activitiesç
  • Having a decreased sex drive
  • Being unable to experience pleasure
  • Experiencing thoughts of death or suicide
  • Talking very slowly
  • Having an increased appetite or experiencing weight gain
  • Being forgetful

What are the stages of bipolar disorder?

Recent research shows that identifying the stages of bipolar disorder is not a simple task. Most commonly, the stages are based on the occurrence and recurrence of mood episodes, which suggest a worsening of symptoms.

  • Stage 0: The identification of a person as being at risk of bipolar disorder
  • Stage 1: The period between the appearance of initial symptoms and the first manic or depressive episode
  • Stage 2: The first manic or depressive episode
  • Stage 3: Recurrent manic and depressive episodes
  • Stage 4: Chronic, unremitting illness

However, recurrence of symptoms may not reflect the development of the illness itself, but may be a consequence of ineffective treatment

What are the early signs of bipolar disorder?

Bipolar disorder can occur at any age, although it is typically first seen from the late teens to the mid-20s. Symptoms can vary from person to person, but it is important to recognise severe mood swings. If a person is experiencing at least three symptoms of mania and having depressive episodes that prevent them from undertaking everyday activities, it is important that they speak to a doctor. Addressing these symptoms early on can prevent the episodes getting worse.

Causes, risk factors and life expectancy

Bipolar disorder can vary from person to person, and there are many different causes. The long-term outlook for people with the condition also varies between individuals.

What causes bipolar disorder?

There is not thought to be one single cause of bipolar disorder. It is likely that there are a number of risk factors, which interact to produce the abnormal functioning of brain circuits that causes the symptoms. These include:

  • Extreme stress, overwhelming problems, and life-changing situations such as the death of a loved one or other traumatic event
  • Genetic variations and chemical imbalances in the brain
  • Environmental factors, including alcohol or substance abuse and lack of sleep

Is bipolar disorder hereditary?

Research has found that bipolar disorder is a condition that can run in families. People who have a first-degree relative (a parent or sibling) with the disorder may be at higher risk of developing the disorder themselves, although most people with a family history of bipolar disorder will not develop the condition.

Who gets bipolar disorder?

Men, women, and children from all backgrounds can get bipolar disorder at any time in their lives, although it rarely develops after the age of 40.

How long can you live with bipolar disorder?

Bipolar disorder is a lifelong condition; although the symptoms can come and go, it requires ongoing treatment and does not go away on its own.


A study of the mortality (death) risk in mental disorders found that people with bipolar disorder, among other conditions, had an increased risk of mortality compared with the general population.


However, the right long-term, ongoing treatment can help control symptoms and enable people with bipolar disorder to live a long and healthy life.

Diagnosis

The earlier that bipolar disorder is diagnosed and a treatment plan created, the less likely it is that the condition will develop further.

How is bipolar disorder diagnosed?

Bipolar disorder is currently diagnosed by looking at a person’s history and symptoms, rather than with brain imaging or other diagnostic tests. People with bipolar disorder are more likely to seek help when they are depressed than when they’re manic or hypomanic, but it is important to talk to a doctor if ongoing, recurring symptoms of either state are noticed. The doctor can complete a physical examination and order medical tests to rule out other conditions.


If necessary, a mental health professional will conduct a mental health evaluation that will look at symptoms, lifetime history, experiences, and often family history. Sometimes medications and other illnesses, such as steroid treatment or a thyroid problem, can cause symptoms similar to those of bipolar disorder, so doctors may also evaluate these other unrelated illnesses or medications while they consider the diagnosis.

Test to diagnose bipolar disorder

There are no specific medical tests to establish a diagnosis of bipolar disorder. However, a mental health specialist will ask questions about symptoms, feelings and emotions. To support their clinical assessment, they will use questionnaires such as the Mood Disorder Questionnaire (MDQ) to check whether patients might have the disorder, the Clinical Global Impressions-Bipolar Version (CGI-BP) scale that can be used to assess the severity of the illness, the Young Mania Rating Scale (YMRS) to assess the severity of manic states, and the Hamilton Depression Rating Scale (HDRS) to assess severity of, and change in, depressive symptoms.

Treatment and medication

Bipolar disorder is a lifelong illness that can come and go over time. Long-term continuous treatment can help to delay, prevent, or manage the severity of acute mania or acute depressive episodes and any lingering symptoms that may occur between these episodes. It is also important for people experiencing hypomania to undergo treatment to limit the development of severe mania or depression.

How is bipolar disorder treated?

An effective treatment plan often includes a combination of medication and talking therapy. Studies show that appropriate treatment for the times between episodes (known as the maintenance phase) should be considered when selecting treatment for the acute phases of bipolar disorder, to ensure that the acute phases are fully managed.

Medication

Medications used to treat bipolar disorder include mood stabilisers, second-generation anti-psychotics, and drugs that target sleep or anxiety. Doctors can also prescribe anti-depressant medication for depressive episodes, combined with a mood stabiliser to prevent manic episodes. Anti-anxiety medications can be used to calm the anxiety and agitation related to a manic episode. Some people may need to try different medications before they find the ones that work best for them. Once these are found, treatment can be very effective, and many people can live fully functional and successful lives.

Therapy and intervention

Psychotherapy (talking therapy) can provide education and support to help a person with bipolar disorder come to terms with the illness. It can help a person identify and change their troubling emotions, thoughts, and behaviours.

A range of psychotherapies can be used to treat bipolar disorder, including cognitive behavioural therapy, family-focused therapy, interpersonal and social rhythms therapy, mindfulness-based cognitive therapy, and dialectical behaviour therapy.

The type, frequency, and regularity of the therapy are based on individual need. There are also several interventions that people might find helpful to manage bipolar symptoms. These include:

  • Electroconvulsive therapy (ECT):A brain stimulation procedure delivered with anaesthesia to treat severe symptoms. It is usually delivered as a series of treatments over several weeks, but can also be effective when a rapid response is needed.
  • Transcranial magnetic stimulation (TMS):A brain stimulation procedure using magnetic waves delivered while a patient is awake. Treatment sessions occur every day for a month.

Diet

Research is limited, but some studies suggest there may be a relationship between diet and bipolar disorder.

There is no specific ‘bipolar diet’, but in general, eating a balanced diet, low in saturated fats and simple carbohydrates and full of nutrient-dense foods, can be beneficial in maintaining a healthy lifestyle.

In addition, drinking only moderate amounts of caffeinated drinks (and not stopping them abruptly) can help prevent someone becoming overstimulated.

Exercices

Studies have shown that exercise can be beneficial in dealing with the depressive phase of bipolar disorder. Regular aerobic exercise such as jogging or swimming can have a positive effect on mood, help to combat stress, help with anxiety, and promote better sleep, while anaerobic exercise such as yoga or Pilates can produce a calming effect.

People with bipolar disorder often live a sedentary lifestyle, and this can contribute to a high level of other diseases such as type 2 diabetes and heart disease. Aerobic exercise is also healthy for the heart and brain, and so can help prevent further illnesses occurring.

Despite the benefits of exercise, it could exacerbate manic symptoms for some people. For this reason, it is important to work with a doctor to find the right exercise plan.

Prevention

It’s not possible to prevent bipolar disorder but getting a diagnosis and treatment as soon as symptoms are identified can help prevent the condition from getting worse.
People who have already been diagnosed can prevent minor symptoms from becoming acute episodes by:

  • Looking out for warning signs: Call a doctor if symptoms or triggers are noticed early on.
  • Avoiding drugs and alcohol: These can make symptoms worse and more likely to return.
  • Taking medications as instructed: Stopping or reducing medication without medical guidance may cause a withdrawal effect, and symptoms could return or get worse.

Scientific studies

Studies into causes, risk factors, and treatment of bipolar disorder are broad and numerous.
In particular, scientists are working to identify any genes that may be involved in causing the disorder. While bipolar disorder is known to be more common in people who have a first-degree relative with the condition, researchers are still identifying what the relevant genes are and how they work together. A global team of researchers has recently identified 30 areas of the human genome where variations in the genetic code can increase the risk of developing bipolar disorder.


Researchers are also looking closely at the composition of the gut microbiota (the ‘good’ and ‘bad’ bacteria and other microorganisms that live in the intestine) and its relationship to brain function in people with bipolar disorders. Studies have found that the composition of the gut microbiota may be altered for these people.


It is hoped that continued research into these areas will lead to the development of new, more effective, and better-targeted treatments.


Research is also ongoing into the best treatments for people with bipolar disorder. This includes studies to assess the effectiveness of drug and non-drug therapies for treating acute manic or depressive symptoms and preventing relapse in adults with the disorder, and studies to determine whether intensive psychotherapeutic intervention at the earliest stages of bipolar disorder can prevent or limit its full-blown onset.

Referenced sources

  1.  National Institute of Mental Health. Bipolar disorder. Accessed February 2021. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml
  2.  Novick DM, Swartz HA. Evidence-based psychotherapies for bipolar disorder. Focus (Am Psychiatr Publ). 2019;17(3):238-248. doi:10.1176/appi.focus.20190004
  3.  Ritchie H, Roser M. Mental health. Our World In Data. Published April 2018. Accessed February 2021. https://ourworldindata.org/mental-health
  4. Fajutrao L, Locklear J, Priaulx J, Heyes A. A systematic review of the evidence of the burden of bipolar disorder in Europe. Clin Pract Epidemiol Ment Health. 2009;5:3. doi:10.1186/1745-0179-5-3
  5.  Pini S, de Queiroz V, Pagnin D et al. Prevalence and burden of bipolar disorders in European countries. Eur Neuropsychopharmacol. 2005;15(4):425-434. doi:10.1016/j.euroneuro.2005.04.011
  6.  Malhi G, Bell E, Morris G, Hamilton A. Staging bipolar disorder: an alluring proposition. Bipolar Disord. 2020;22(7):660-663. doi:10.1111/bdi.13020
  7.  Berit K. Toward a deeper understanding of the genetics of bipolar disorder. Front Psychiatry. 2015;6:105. doi:10.3389/fpsyt.2015.00105
  8.  Chesney E, Goodwin G, Fazel S. Risks of all‐cause and suicide mortality in mental disorders: a meta‐review. World Psychiatry. 2014;13(2):153-160. doi:10.1002/wps.20128
  9.  Yatham L, Kennedy S, Parikh SV et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97-170. doi:10.1111/bdi.12609
  10.  Cruz N, Sanchez-Moreno J, Torres F, Goikolea JM, Valentí M, Vieta E. Efficacy of modern antipsychotics in placebo-controlled trials in bipolar depression: a meta-analysis. Int J Neuropsychopharmacol. 2010;13(1):5-14. doi:10.1017/S1461145709990344
  11.  McMahon K, Herr N, Zerubavel N, Hoertel N, Neacsiu AD. Psychotherapeutic treatment of bipolar depression. Psychiatr Clin North Am. 2016;39(1):35-56. doi:10.1016/j.psc.2015.09.005
  12.  Escamilla MA, Zavala JM. Genetics of bipolar disorder. Dialogues Clin Neurosci. 2008;10(2):141-152. doi:10.31887/DCNS.2008.10.2/maescamilla
  13. Stahl EA, Breen G, Forstner A et al. Genome-wide association study identifies 30 loci associated with bipolar disorder. Nat Genet. 2019;51:793-803. doi:10.1038/s41588-019-0397-8
  14.  Lu Q, Lai J, Lu H et al. Gut microbiota in bipolar depression and its relationship to brain function: an advanced exploration. Front Psychiatry. 2019;10:784. doi:10.3389/fpsyt.2019.00784
  15.  US Agency for Healthcare Research and Quality. Treatment for bipolar disorder in adults: a systematic review. Effective Health Care Program. Published August 7, 2018. Accessed February 2021. https://effectivehealthcare.ahrq.gov/products/bipolar-disorder-treatment/final-report-2018
  16. Novick DM, Swartz HA. Evidence-based psychotherapies for bipolar disorder. Focus (Am Psychiatr Publ). 2019;17(3):238-248. doi:10.1176/appi.focus.20190004
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